Are You a Patient or a Person?

Too many Americans live under medical control. We take multiple drugs to prevent bad things from happening to us. We are screened regularly for other potential diseases. Is all this medical intervention really good for us? Nortin Hadler, MD, says no.

Dr. Hadler is no radical or alternative medicine guru. He’s a rheumatologist and a professor at the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill. But in his book The Last Well Person Hadler makes a strong case that a large chunk, perhaps most, of American medicine does as much harm as good. The evidence supporting many therapies is weak and skewed by the influence of funders and sponsors. He implores us not to put blind faith in our doctors, but to keep control of our own lives and health.

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Some examples: Hadler says coronary artery bypass surgery should almost never be done, because the risks outweigh the benefits. Prostate cancer screenings, he notes, come with risks of their own. He further contends that routine mammograms are unreliable, with many false negatives and false positives, since they cannot distinguish dangerous tumors from less-dangerous lumps that should be left alone. They lead to too many unnecessary biopsies and surgeries. Based on research, Hadler also criticizes the routine use of statin drugs for cholesterol, and screening colonoscopies for people who are not in their 50s or 60s.

We are all going to die — “The death rate is one per person,” says Hadler. The major controller of longevity and health is the difficulty of our lives. According to Hadler, socioeconomic status (SES) is the biggest determinant of longevity, job satisfaction is second, and social connection is third. Medical treatments don’t have much to say about it.

Hadler says the system is “medicalizing” our lives, turning everything from job performance to attention span to orgasms into medical problems. But they have no effective treatments for these problems. Why are we wasting so much time, energy, money, and comfort following doctors’ orders? We should focus instead on maximizing our quality of life.

How does Hadler’s insight relate to diabetes? For one thing, he thinks we should take a more relaxed approach to Type 2 in elders. “‘Normal’ blood sugar is age-dependent,” he writes. As glucose levels go up, risk of death increases only very gradually among older people. People can run higher-than-normal blood sugars and still be well. Hyperglycemia will cause damage over time, but older people have less time left for those complications to happen.

Hadler is critical of the United Kingdom Prospective Diabetes Study, which supposedly proved the value of tight control for people with Type 2. This study enrolled about 5,000 newly diagnosed Type 2s, age 48–60. After 12 years, the intensive therapy group showed less protein in their urine, and less leakage from blood vessels in the eyes. But they showed no decrease in eye or kidney damage, strokes or heart disease, peripheral neuropathy or all-cause mortality (although a follow-up ten years later found such a mortality difference.) So why, he asks “would anyone declare UKPDS supportive of intensive therapy?”

He says we should be even more cautious about the so-called “metabolic syndrome.” Over 40% of Americans aged 60—70 (and 25% of all adults) would qualify as having metabolic syndrome under the current definition — a large waist, bad cholesterol, high blood pressure, and high blood sugar. (Having three out of four qualifies you for the syndrome.) But strangely, American life spans have increased as the rate of metabolic syndrome has climbed. And the Americans who die the youngest, African-American men, have lower prevalence of metabolic syndrome than white men, white women, or African-American women. So how important could metabolic syndrome be?

Hadler believes that millions of people are being defined as “sick,” often based solely on lab numbers, so that drug companies and others can profit from “treating” us, whether or not the treatment actually makes our lives better or longer. He says we have a choice between being self-reliant individuals who think of ourselves as “well,” or becoming patients, depending on the medical system to tell us how we’re doing.

The downside of becoming a patient is loss of self-confidence, freedom, and possibly self-esteem. Most readers of this blog are already “patients” in the eyes of the system. Can you consider yourself a “well” person who just happens to have a health problem, one you can deal with? Or do you see yourself relying on doctors more and more? Hadler says being a well person (instead of a patient) requires courage to ask questions, do research, and sometimes say no to our doctors. Is that something you are prepared to do?

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I’ve got a new entry on my blog, Reasons to Live, about a cool guy who helps isolated older women and finds it rewarding. If you want some inspiration, check it out at http://davidsperorn.com/blog

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Deb

I consider myself a well person despite my diabetes, arthritis, fibromyalgia and assorted other difficulties. I am doing many things to stay that way, including taking medicines, adjusting my lifestyle, eating and stress levels to improve my coping with these chronic conditions.
What Hadler is saying about blood sugar rising with age is the same thing that used to be said of blood pressure rising with age. Blood pressures that were considered normal for older persons were contributing to earlier deaths than they would with current treatments.
My ancestors are all deceased, many of them at ages younger than I am now. One of them was my great-grandmother whose Type 2 diabetes was treated with insulin with no glucose meters and no lab tests. She had to weigh every morsel of food and did not live very long or happily after becoming a diabetic.
If my father and his parents had had access to better medical treatments they would have lived to see my daughter.
That said, I consult my health care professionals; I don’t go to see them with the intent that they will rule my life. But under extreme circumstances such as when 2 of my heart valves failed and again when my kidneys failed, I let them control all aspects of my treatment until good health was restored. There has to be a balance.

calgarydiabetic

Well the UKPDS study I can’t comment about but a study of 2 my brother and I highlights the importance of keeping the blood sugar in the normal range as much as possible. He had severely gangrened feet and died at 73 years of age and it is very possible that I will not make it to 73. My ophto always complains that he does see much eye damage as in the good old days. He thinks it could be metformin.

On the other side there is way too much marketing of drugs. Many have serious side effects or no net benefit.

Sorry, I think this guy is “whacked”. Having successfully been a Type 1 diabetic since 1965, his philosophy is totally incorrect. Among other things, I fought off chest pains with stents and other drugs only to end up with a total blockage where the EMT’s luckily restored my heart with 7 paddle shots whereby the Doc’s said a triple bypass was the only solution. I am, at 66, totally recovered, and enjoying an active life that would not have existed if I followed his plan.

I kind of agree with Deb that Dr. Hadler may be wrong about sugars naturally rising with age. I think that’s just because people tend to move less as they age. If you stay active, it won’t happen. I should have put that in the article.

Other than that, I think Hadler is right about bypass surgeries, mammograms, colonoscopies, etc. being as harmful as they are helpful. Many Americans could benefit from having LESS medical care.

John_C

I agree with Dr. Hadler — well mostly!

In the end I suppose it is all about balance and you (like in me) taking the responsibility and control for one’s condition.

My Doctor (like so many) had a nasty habit of treating me like a mushroom (keeping me in the dark)and I was just supposed to take his pills (lots) and advice because I wasn’t a medical person so I am not capable of treating myself or making decisions. So I studied, and studied some more, and today my diabetes is under MUCH better control. Yes my Doctor would hardly even talk to me (only for a couple of years though) and finally asked me “how did you do that”. He admitted that Diabetics with the best outcomes are those who take control by understanding their disease and treatment.

Knowledge is a wonderful thing. Just have to stop watching American TV and all those “pill ads”. There was a comment here but I thought I’d better delete it — you probably know what I was going to say anyway.

-John-

Mary G

I agree with Dr. Hadler…I was diagnosed type 2 three years ago after having a stroke. Since then, I found out that most doctors are too busy to actually “treat” their patients. Once you are in a medical situation as I was, they now go by their STANDARD OF CARE BIBLE and subsequently prescribe every pill, screening & procedure imaginable to cover their butts…whether its needed it or not. No “independent” thinking here!!! It did not matter that I was suffering from serious side effects that hampered the recovery from my stroke. I found out the hard way that a patient needs to be part of the recovery equation. They need to educate themselves and ask questions or change doctors until one is found that will listen before prescribing anything. I had to change 4 times to accomplish this goal. It come down to this…you can either take control of your health and life or let the overly busy doctor do the work for you. Of course, we do what we feel is right for ourselves. If you believe you need to do everything the doctor says without question, that is your perogative. I ,on the other hand, prefer to stay happy and healthy and keep my money in the bank…and not give it to the drug company and be miserable and poor.

A. Austin

I agree with some of the information listed. How ever there are some problems with his take on coronary bypass surgery. I had a 4 way bypass in 1992, Had 5 stents put in from 1996 until 2006. I had a 3 way bypass in 2010. I’m 72 years of age now, if I had followed his advice, I don’t think I would be writing this.

Patricia Pollard

I think he is a nut. I would not want him to treat me…and also anyone who tries to treat themselves have big fools for doctors.

Bev

It’s a difficult question. We have the means to correct many problems that used to cause death or great discomfort. However, we also know “too much” and seem to be constantly on the lookout for something that could go wrong. We’re supposed to have this test or that procedure when we reach a certain age because we might have a problem that can be dealt with if we catch it soon enough. One has to find a balance. I have had a fairly healthy life for 30 years with insulin dependent diabetes. I decided early on to learn everything I could and try to live a full life and keep my disease under control.

Laura

REally?!! sounds like a man who would be in favor of rationed government healthcare. This guy seems to think that since we are all going to die then why not sooner rather than later. I for one do NOT have a death wish. How crazy to even say that. My husband had a routine prostate check and returned at a level that most such as Dr Hadler would say was unnecessary to check out…Thank God our doc did a check and my husband’s life was saved. Dr Hadler can refuse any treatment he wants to(just don’t do that for me) but obviously has an agenda and flawed information. I won’t even mention his worldview.

David Spero RN

Hi Laura,

Thanks for your comment. I’m glad your husband is still with you, but could you please explain how this prostate check “saved his life?” This is where I think Dr. Hadler is totally right, and has the evidence to back him up. Treatments for many conditions, including prostate cancer, are not shown to prolong life or improve quality of life.

Tia

I wonder what color the sun is in his world?

Where do you get these wack jobs you write about? I’m just wondering.

Laura

My dh was positive for prostate cancer.He had no real symptoms but came back with a higher than expected Gleason score which came from a biopsy that docs were reluctant to give and which I am sure Dr Hadler would have said were unnecessary based on his screening test. If not for the screening and proactive follow up, he would have had an end stage situation. As it was, he was able to be treated asap. He was much further along cancer wise than would be expected from his “borderline” screening results. It surprised the docs but we are so so very thankful that he was screened.

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